Nutritional and lifestyle supportive care recommendations for management of obesity with GLP-1 - based therapies: An expert consensus statement using a modified Delphi approach.

BACKGROUND: Liraglutide, semaglutide and tirzepatide have transformed the management of obesity. However, dose-related gastrointestinal effects, obesity-associated nutritional insufficiencies, and poor long-term adherence may limit their long-term health benefits. Despite a recent joint advisory summarizing nutritional and lifestyle supportive care priorities with these therapies, there is still a significant lack of direct evidence to guide clinical practice, making consensus-based recommendations necessary. METHODS: The consensus statement development was based on an initial scoping review that included searching PubMed, Embase, Web of Science, Cochrane, and Medline for relevant scientific publications from January 1, 2021 through June 30, 2025. An international multidisciplinary panel consisting of physicians, clinical researchers, and dietitians employed a modified Delphi process to develop clinical practice recommendations for nutritional and lifestyle strategies that may assist people on glucagon-like peptide 1 based therapies (GBT) in optimizing treatment experience and improving health outcomes. RESULTS: A total of 52 consensus statements were developed, outlining key considerations for the practical management of obesity and associated complications with GBTs, with a focus on nutritional factors in relation to obesity, body composition, physical activity, and the management of common gastrointestinal symptoms such as nausea, vomiting, diarrhoea, and constipation. The consensus statements include practical strategies supporting the weight loss journey, from before starting a GBT, during the weight loss and weight maintenance phases, and in case of GBT discontinuation. The statements were primarily derived from indirect evidence, including from existing evidence and established guidelines for nutrition therapy in bariatric medicine and relevant clinical experience. CONCLUSIONS: These expert consensus recommendations offer healthcare professionals practical guidance on nutritional and lifestyle interventions for patients undergoing GBT-related weight management, complementing current recommendations. Further direct evidence is urgently required to inform and enhance optimal clinical care.